Chapter 30
Basic Pediatric Nursing Care
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
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Concepts of Child
Development
• Infancy: birth to 1 year
– Trust versus mistrust
• Toddler: 1-3 year-old
– Autonomy versus shame and doubt
• Preschool: 3-5 year-old
– Initiative versus guilt
• School age: 6- 12 year old
– Industry versus inferiority
• Adolescence: 13-18 year old
– Identity versus identity confusion
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Pediatric Nursing
• Purpose of Pediatric Nursing
– Preventing disease or injury
– Achieving and maintaining an optimum
level of health and development
– Treating and rehabilitating children who
have health deviations
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
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Pediatric Nursing
• Family-centered Care
– A philosophy of care
– Family as the constant in the child’s life
and holds that systems and personnel
must support, respect, encourage, and
enhance the strengths and competence
of the family
See Box 30-2
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Pediatric Nursing
• Partnerships with Parents
– Parental involvement
– Parents are treated as equals
– Parents of special needs children often
become experts
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Pediatric Nursing
• Future Challenges for the Pediatric
Nurse
– Shift from treatment of disease to
promotion of health
– Technological advances
– Adolescent medicine
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
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Pediatric Nursing
• Nursing Implications of Growth and
Development
– Measurement of physical growth
• Percentiles on growth charts
– Anticipatory guidance
• Psychological preparation of a patient for an
event expected to be stressful
See Health Promotion Considerations
Christensen pg. 955 and Table 30-1
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Screening Programs
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Physical Assessment of the
Pediatric Patient
See Christensen Box
30-3 & 30-4
• Growth Measurements
– Length
• Measurements are taken when children are
supine until 2 years of age.
– Height
• Measurement is of a child standing upright.
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Figure 30-1
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Measurement of head, chest, and abdominal circumference and crown-to-
heel measurement.
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Physical Assessment of the
Pediatric Patient
• Growth Measurements (continued)
– Weight
– Head circumference
– Skin Thickness
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Figure 30-2
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
A, Infant on scale. B, Toddler on scale.
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NCLEX Test Plan
Categories
7. Reduction of Risk Potential
Vital Signs
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Physical Assessment of the
Pediatric Patient
• Vital Signs
– Temperature
• Reflects metabolism
• Routes: oral, rectal, axillary, and tympanic
• Normal findings approximately 97° F to 99° F
– Heart Rate/Pulse
• Apical pulse: infants and young children; radial
pulse: children 5 years of age and older
• Pulse rate should be counted for 1 full minute.
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Physical Assessment of the
Pediatric Patient
• Vital Signs (continued)
– Respirations
• Rate, depth, and quality should be assessed.
• 1 full minute in infants
• Rate may be as rapid as 40 to 50 breaths per
minute, gradually slowing to 25 to 32 per minute.
– Blood Pressure
• Children 3 and older.
• Use anticipatory guidance
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Data Collection Techniques
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment
– Skin
• Pallor: anemia, chronic disease, edema, or
shock.
• Erythema: increased temperature, local
inflammation, or infection.
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Accessory Structures
• Hair
• Nails
• Handprints and footprints
– Eyes
– Ears
• Inspect for general hygiene.
• Advise parents and children to clean the ears
with a washcloth; wipe only the outer portion of
the canal with a swab.
• Mineral oil may be used to soften cerumen.
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Nose, Mouth, and Throat
– Lungs
• Not crying.
• Have them “blow out.”
– Chest
• Asymmetry may indicate serious underlying
problems.
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Back
• Newborn is C-shaped.
• Older child typically has S-shaped curve.
• Marked curvature in posture is abnormal.
– Abdomen
• Inspection: cylindrical and flat
• Auscultation: listen for peristalsis
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Figure 30-7
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Development of spinal curvatures.
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Extremities
• Examine for symmetry, range of motion, and
signs of malformation
– Renal Function
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Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
– Anus
• Check the anal sphincter
• History of bowel movements
• Assess for perianal itching; may be pinworms.
– Genitalia
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages
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Normal Development
• Infancy
– Gross Motor
• Head control
• Locomotion
• Toddler
– Parallel play
– Gross Motor
• Running/skipping/hopping/jumping
– Fine Motor
• Scribble/draws circle
• Preschool
– Refines gross motor and fine motor skills
– Cooperative play
– Seeks information
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Normal Development
• School age
– Learns work habits, organization, goals
– Refines gross/fine motor skills
– Socialization skills
• Adolescent
– Peers important
– Develop value system
– Philosophy of life
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Factors Influencing Growth
and Development
• Nutrition
• Metabolism
• Sleep and rest
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
Developmental Stages and Transitions
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Factors Influencing Growth
and Development
• Speech and Communication
– Crying at birth
– Cooing, laughing, or babbling.
– By 9 months, infants practice and repeat the noises
they can make
– A 1-year-old has a three- to four-word vocabulary; by
18 months, they usually know 25 to 50 words; by 2
years, they may know more than 250 words.
– Rule: # words in sentence = age + 1
– Non verbal communication
See Christensen Box 30-9
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NCLEX Test Plan
Categories
1. Coordinated Care
Advocacy
Client Rights
Informed Consent
Legal Responsibilities
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Hospitalization of a Child
• Preadmission Programs
– Child’s level of understanding and stage
of development
– An emergency admission thrusts the
child into an unknown environment
surrounded by strange equipment,
frightening sounds, and unfamiliar
adults.
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Hospitalization of a Child
• Hospital Policies
– Parental involvement
– After a child is admitted, a nursing
history is obtained; an identification
bracelet is usually worn on the wrist.
– Vital signs and weight are measured and
recorded.
– Blood samples drawn by a laboratory
technician
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Hospitalization of a Child
• Developmental Support for the Child
– Interruption of normal routines and
threatens normal developmental process
– Children to regress when hospitalized
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NCLEX Test Plan
Categories
5. Physiological Integrity: Basic Care
and Comfort
Validate pain using rate scale.
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Hospitalization of a Child
• Pain Management
– Wong-Baker Faces Scale
– Non verbal behaviors of pain
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NCLEX Test Plan
Category
8. Physiological Adaptation
Perform care for client before and
after surgical procedure.
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Hospitalization of a Child
• Surgery
– Anticipatory guidance
– Six Common Stress Points
• Admission, blood tests, the afternoon of the
day before surgery, injection of
preoperative medication before and during
transport to the operating room, and return
to the postanesthesia care unit
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NCLEX Test Plan
Categories
Physiological Integrity
5. Basic Care and Comfort
ADLs
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Common Pediatric
Procedures
• Bathing
– Use dry hands to pick up the infant.
– Allow play and splash.
– Toddlers love to be placed in a tub for their
bath.
– Toys should be provided.
– Never be left in a tub without supervision.
– School-aged children may be reluctant to
bathe; encourage them to participate in their
care.
– Adolescents; privacy is important.
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NCLEX Test Plan
Categories
Physiological Integrity
5. Basic Care and Comfort
ADLs and
Care of feeding tubes
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Common Pediatric
Procedures
• Feedings
– Breastfeeding
• If the mother is unable to be present for every
feeding, encourage her to use a breast pump;
bottles of breast milk can be frozen and given
later by bottle or tube feeding.
– Solids
– Gavage
– Gastrostomy
– TPN
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NCLEX Test Plan
Categories
2. Safety
Injury Prevention
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Common Pediatric
Procedures
• Safety Reminder Devices
– Types
• Elbow safety reminder
• Mummy safety reminder
• Clove-Hitch safety reminder
• Jacket safety reminder
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Figure 30-10
(From Lowdermilk, D.L., Perry, S., Bobak, I.M. [1997]. Maternity & women’s health care. [6th ed.]. St. Louis:
Mosby.)
Mummy restraint.
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NCLEX Test Plan
Categories
Physiological Integrity
7. Reduction of Risk Potential
Diagnostic Tests
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Common Pediatric
Procedures
• Urine Collection
– Methods of Collection
• Suprapubic bladder tap
• Plastic urine collection bags
• Catheterizations
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Figure 30-11
Suprapubic bladder aspiration.
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Figure 30-12
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
Application of a urine collection bag.
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Figure 30-13
Venipunctures to Obtain Blood Specimens
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
Correct position for jugular venipuncture procedure.
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Figure 30-14
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
Position for femoral venipuncture procedure.
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Figure 30-15
Lumbar
Puncture
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
A, Modified side-lying position for lumbar puncture. B, Older child in side-
lying position.
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NCLEX Test Plan
Category
Safe and Effective Care Environment
1. Coordinated Care
Resource Management
Recognize client need for materials
and equipment
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Common Pediatric
Procedures
• Oxygen Therapy
– Methods
• Hood and incubator
• Mist tents
• Nasal cannula
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Figure 30-16
(From Wong D.L., Perry, S.E., Hockenberry-Eaton, M.J. [2002]. Maternal-child nursing care. [2nd ed.]. St.
Louis: Mosby.)
Oxygen is administered to an infant by means of a plastic hood (Oxy-
Hood).
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NCLEX Test Plan
Category
8. Physiological Adaptation
Intervene to improve client
respiratory status
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Common Pediatric
Procedures
• Suctioning
– Bulb syringe, straight suction catheter
– Depth: approximately 1/4 to 1/2 inch
– Timing: not more than 5 seconds
– Frequency: allow 30 seconds between
attempts
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NCLEX Test Plan
Categories
3. Health Promotion & Maintenance
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Common Pediatric
Procedures
• Intake and Output
– All fluids given to a child are
documented on a record kept at the
bedside
– All urine voided is measured before it is
discarded; weigh diapers
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NCLEX Test Plan
Categories
Physiological Integrity
6. Pharmacological Therapies
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Common Pediatric
Procedures
• Medication Administration
– Compute the dose correctly
– Dosages must be checked by a second nurse for
safety
– The right amount of the right medication must be
given to the right child at the right time and via
the right route.
– Observe and document a child’s response to the
drug.
– Consider age, body weight, and body surface area.
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Common Pediatric
Procedures
• Medication Administration
(continued)
– Routes of Administration
• Oral
• Intradermal, subcutaneous, and
intramuscular
• Intravenous
• Optic, otic, and nasal
• Rectal
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Figure 30-17
(Courtesy of Marjorie Pyle, RNC, Lifecircle, Costa Mesa, California.)
Intramuscular injection sites.
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NCLEX Test Plan
Category
Safe and Effective Care Environment
2. Safety
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Safety
• Protect child from harm
• Anticipatory guidance
• Health teaching
• Injuries cause more deaths and disabilities
in children
• Parents and children should talk and listen
to each other to prevent many accidents.
• The adult who is a role model can influence
a child immensely.
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